Systems leadership in the NHS in England focuses on leading beyond organisational and professional boundaries to implement policy changes and meet budget requirements. However, despite increased recognition, there is no commonly agreed definition of what NHS systems leadership entails.
The NHS Leadership Observatory commissioned a team of researchers led by Dr Axel Kaehne and Dr Julie Feather from Edge Hill University’s Evaluation and Policy Unit to undertake the review of systems leadership, with support from Professor Naomi Chambers and Professor Ann Mahon from the Alliance Manchester Business School at the University of Manchester.
Their report has identified that the NHS lacks a clear definition of what systems leadership means and what qualities NHS leaders need to fulfil their roles. It recommends carrying out further studies to close these gaps and write a clear definition for NHS leaders to adhere to.
Postdoctoral Research Fellow Dr Julie Feather, who is part of Edge Hill’s Evaluation and Policy Analysis Unit, said: “Systems leadership refers to leadership attributes, qualities, behaviours, mindsets and actions which have a system-wide impact.
“This complex set of skills is essential in the modern NHS, but our report identified that leaders in the NHS don’t fully understand their role or the importance of being systems leaders which must be urgently addressed.”
The review is set against a policy background of the formal establishment of 42 Integrated Care Systems (ICS) across the NHS in England in July 2022. These are partnerships between the organisations that meet health and care needs across an area, aiding in cooperation and planning.
The creation of ICS means that more than ever NHS system leaders are required to have the skills necessary to steer and manage dynamic transformations across organisations. Adding to this is the need to balance longer term system sustainability with the reality of limited resources, all while improving population health outcomes and tackling health inequalities.
Existing NHS policies and research do not offer any generic set of skills for this type of work.
Reader in Health Services Research and project leader Dr Axel Kaehne added: “Our report identifies the complexity of being a systems leader and calls for further analysis to determine what training and development will be needed to ensure NHS leaders are properly supported to be able to steer and manage change in an increasingly unpredictable external environment.”
Professor of Health Leadership Ann Mahon from Alliance Manchester Business School said: “One of the important findings of our review was an almost universal absence of research on equality, diversity and inclusion as a critical perspective on the development of effective system leadership either from the workforce or the community perspective. This is a serious gap in the research that needs to be addressed.”
Other recommendations in the report include examining the needs of systems leadership within the context of the newly developed Integrated Care Boards; exploring how Equality, Diversity and Inclusion (EDI) can be embedded into business as usual through the lens of systems leadership; and explore how leaders can embrace technological advances.
The full report can be accessed online.